HomeMy WebLinkAbout2012 CALVERT AVE - Building Permits -- _. . ._...Applicant to fill in all.spaces except those within heavy border lines and sign all appropriate.declarations. -- - - - - -
PERWIT NO. TRACT NO. ,LOT N0. _ UNIT-NO.•• ' ' '' ' 1 - I
•
_ -r-UF"COSTA MESA •GN TRU TIO PERMIT - �}" ags/� - - 9765 2/21 /B6
Praject Address •. i& 1. �% . j/ '• I / ie I _• So�Ci •
TL
Applicant's Mailing ••ddress 4 II[Q /. /-7 / 'r • - TYPE OF CONSTRUCTION- ' U NEW -H ADD. H ALTERATION I—I/ REPAIR 1 1' - 99
• ,i ; • - 1/I a -❑ CONVERSION ❑ DEMOLISH ❑ OTHER - A.P.# - Zone - - - I
Owner's Name - - • - Phone - -DESCRIPTION OF WORK/USE OF BLDG.
Address L�Q JJ"-l•�� - • • S Main Building: - - 'AccessoryBullding: ' - -
Arch/En - • -- ' —License No. TYPE OF PERMIT t• - E - Z
Arch/Eng ❑ GRADING-' ❑ STRUCTURAL T, Front p
Address ,, • ❑ TENANT ❑ ELECTRICAL ••• PLUMBING ❑ MECHANICAL B Rear - _ N
Contractor's Name 11%,. ��✓ a -�L.-� • Phonea* � ,,,I. l ❑ OTHER " - •• � Right - - ' N •i
����,�� / Y PROJECT DESCRIPTION SQ. FT: ' • - OCCUPANCY - G
' Address(mailing) ' • AISAW2A r./_ J P. K Left c' - - '
' �✓� - - CON STRVCTION TYPE VALUATION$ $ - , R.
City License No.• �./s, ZONE—•' - GRADING CU. ' ACRES 1 - _ E
LICENSED CONTRACTOR DECLARATION I - _ - Ping. Ref.# Parking Req./Provided �I
• G
I hereby affirm that;I am licensed under provisions of Charter 9 (commencing Remarks: - ' • Planning Notes: '4 RECEIVED
� t p^q' ' -
with section 7000) of Division 3 of the fgusiness and Professions Code, and flCC EIVED F 1 (�a-; T
my license is in f ,f• . and effect. 1 - •
1 • - • I 19 - S;
License la / I. L ic:n iI . . -
Date esti ' 'Signature Iritart:./-,ij//� PLUMBING. , . FEES -
WORKERS' COMPENSATION DECLARATION, —r -
I hereby affirm that I have a certificate of consent to self-Insure or a certificate • Bar Sink • Showers ELECTRICAL ' FEES
(y) of Workers' Compensation
insurance,'-or a certifiieejd'co/pyy--theereof-,(Section Backflow Preventer - Service Sink Automatic Washer. Transformer ❑ 15-50 KW
3800, Lab. cRt 13b /✓O /� �W uflXl Irrigation '- - _ ❑ 50+KW ( �`
Policy No. cop Company S Backflow Irri anon Sewer Ca Construction Pole Sub. ,
CI Certifietl copy is hereby turn ishetl. I t7"Cer&'-/W6
d( pyd' lied with the city •I 'cion Bathtubs I Sewer Connection Cooking Unit -.. Meter Dup to 100 amps
Date "/ "Q 6 Applicant
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION- - - Clarifiers. _ _ . Solar Collectors -. . Dishwasher ;.• _. Meter 0over.100 amps - 2. . _ . .
(This section need not be completed if the permit is for one'hundred ($100) or , -
less). Dishwasher Solar Piping Dryers ❑Gas r0Electr is • Sub Panel
I certify that'in the performance of the work for which this permit is issued, I - - ,
shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank - Fan Motors❑o-1 HP E11%-B I '
Workers' Compensation Laws of California" - - - - -
-
Date Signature _ Floor Drains • SwimmingPool w/Spa.
'NOTICE: If,after making this declaration, you should become subject to the _ p F.A.U. Inc.ISolar ❑9-15 HP ❑16-15+
Workers"Compensation-provisions of the Labor Code, you-must forthwith' -' Floor Sinks , - Urinal - Fixtures ' Microwave
comply 'with such provisions or. this Permit: shall be deemed revoked. 1 - - '
CONSTRUCTION LENDING AGENCY. Gas Service Outlets Water Closet ' ' Device Boxes Pole Light '•
•
I hereby affirm that there is a construction lending agency for the performance _
of the work 'for 'which this permit, is issued (Section 3097 Civ. C:) Interceptors -Water Heater _ / (�y Outlets • Ran e •
Lender's Name. ' . - -�} �]x1Gv"w g •
Lender's Address - ' . Kitchen Sink TT( .Water Service •. , . - _ Switches Sign .
OWNER BUILDER DECLARATION - .. - •
_ •
I hereby affirm that I am exempt from the Contractor's License Law for,the Lavatories ':Auto-Wash , , - Garbage Disposal Standing,Sections
following reason (Section 7031.5 Business and Professional Code: Any city or , ' ' ' - -
county which requires a permit to construct,alter,improve,demolish or repair P-Trap - Laundry Trays Generator ❑0-5 KW ❑5-15 KW Trash Compactor •
any structure, prior to'its issuance, also requires the applicant for such permit - - i
to file a signed statement that he/she Is licensed pursuant to the provisions of Roof Drains • •
the Contractor's License Law (Chapter 9 (commencing with Section 7000)''df - • •
Division 3 of the Business and Professions Code)-or that he/she is exempt - _ - - t - - _ - ;
.therefrom-and the basis for the alleged ekemption. Any violation of Section ' _ $ - - i , '
7031-.5 by. any applicant for a permit subjects the applicant to a civil . - - - • . ' • - . ' ,
. penalty of not more than five hundred dollars($500). ' I .1 ' ,
-0 I, as owner of the property Or. my'employees with wages as their sole ' Reinspection'FeeI I I $15 Issue Fee‘` $ 3
compensation, will do the work, and the•structure is not intended or offered '' -- Reinspection Fee ' I $15 • Issue Fee t $ 3
for sale (Section.7044, Business and Professional Code: The Contractor's ' 'MECHANICAL • I 1 - FEES I
License Law,does not apply to an owner of a property who builds or improves • - ,
thereon, and who does such work-himself/herself or through his or her own - DEVELOPMENT SERVICES REQUIREMENTS: -
employees, provided that such improvements are not intended or offered for Boiler _ I Hood or, Type I 0, • ,
sale. If,.however, the buildin9'orlimprovement is sold within one year of com- Canopy Type II ❑ Zoning Approved By Date
pletion,,the owner will have the burden of proving he/she did not build or im- Duct- Under Ground - Building Approved By Date
prove for the purpose of sale). , y /./jr
0 Las owner of the property, am exclusively contracting with licensed con-' 1 Duct-Structural Refrigeration System Appliption Issued By • 0--.' Date +G �S/O
tractors to construct the project (Section 7044,Business and Professions Code: •
-The Contractor's'License Law-does not.apply-to an owner of property who Duct-Ventilating --' .- - ❑0-100,000.BT.0--❑100,000 BTU - 'SUMMARY OF FEES
builds or improves thereon, and'who contracts for such projects with a con- I
tract orfs) license pursuant to the Contractor's License Law). I am aware that ' ' BUILDING PERMIT , $ - SMIP. $
Exhaust System 0 Multiple 0 System Repair/Alteration - •
proof of their Workers Compensation insurance should be provided to me. PLAN CHECK $ PERMIT '
0 i am'exempt under Section I B.& P.C.for this reason Firepl/Fact.Blt. ICBO'# Fire Dampers ISSUANCE ' $ '
- I - PLUMBING $ ' go o
Date • Owner - Heating System& Ducting ' Registers I PLAN CHECK 425%, $ ENERGY.P.C. $
I hereby certity that I have read this application and state that the above ' - ❑o-100,000 BTU ❑100,0008T ELECTRICAL $ GRADING $ ' ,
information is correct.9 agree to comply With all city and county ordinances ' •
and state laws relating to building construction, and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $
sentatives of this' city to enter upon the above-mentioned 'property for , •/DO
inspection oder o / ' rA .r /�- / 1 MECHANICAL $ TOTAL FEE $ I'�
Signature ( _'..,/.9.1. Date a• 8 ( -
- , + /
� -
065-46,rev. 10/84 White - Building; Canary - Applicant Pink - Accounting; Goldenrod - Assessor
CONSTRUCTION AND PLANNING . _ POOL & SPA
APPROVALS Permit Date Inspector APPROVALS Permit# Date Inspector
O. Temporary Electrical Service or Pole 52. Pool & Equipment Location .
12. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
/ 3. Electrical Conduit Utility-Undrgrnd. - 54. Forms '
I 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
•
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation • 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
110. Structural Floor System • - 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
.13. Roof Drains 64. Plumbing System - Final •
14. Rough Plumbing' 65.• Electrical-Final .
15. Rough Electrical-Conduit - - 66. Solar System-Final -
16. Rough Electric Wiring • 67. Fencing & Access Approval . - '
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. •POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure , 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil . •
23. Gas Pipe-Rough & Test 72. Underground Flush '
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing - 74. Overhead Hydro •
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing& Siding 77. FIXED SYSTEM FINAL
29: Insulation 78. FIRE PREY. FINAL ,
30. Drywall Nailing HEALTH DEPT. REQUIREMENT •
•
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final • 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
•
34. Final Heating & Air Conditioning '
35. Final Gas Pipe-Test - . .
36. Hood or Canopy
37. Final Factory Fireplace,
38. Final.Plumbing • - 3-(Y- can .
39. Water Service-Final is-,
-
40. Gas Service-Final ; • - •
41. Solar Domestic-Final . -1 -
42. Backflow Preventer -
43. Backf low Irrigation
44. .Landscape Irrigation System . . •
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING - •
48. Special Requirements Completed ,
49. Electric Release to Edison - •• .
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. 5181 3., I 845.00 IL
CITY OF COSTA MESA - - - - pEgiy)IT 51p/ TRACT NO. . : LOT NO. ' BLDG.NO. - . -
CONSTRUCTION PERMIT • //J /J �t r
Project Address' •�D/.Z (-. 'J. __ _. TYPE OF CONSTRUCTION Li NEW 'LJ• ADD LI-ALTERATION -❑'REPAI R - ' '• • • - ,
Applicants Mailing Address• '7/ ' .. ❑ CONVERSION ❑ DEMOLISH OTHER- • A.P.# I Zone ' ,
S'HAZLE Y ,4Y/tS 4.-9429 DESCRIPTION OF WORK
Owner's Name / -Phone _ S Main Building: _ Accessory Building: " 2
Address O1.2 C-�rI-LS!_�inT TYPE OF PERMIT ' ❑ GRADING ❑ FOUNDATION E . - o
❑ STRUCTURAL T Front • _ N
Arch/Eng. - - License NO. - ❑ TENANT -❑ ELECTRICAL• ❑ PLUMBING ❑ MECHANICAL •• B Rear ' „ ' - - •
- N
Address ❑ OTHER - - ' • - A.
JL i •pcobe,h�-7 -/8 PROJECT DESCRIPTION SQ. F• T. OCCUPANCY' C Right . G
Contractor's Nam- .- Z. K Left R
Address
(mailing/ I D ��� r CON ST TYPE VALUATION$ $ U
17 / 5', rY!UR1/3 .V 771- ANA 4:2707 .- E
City License No. ZONE - GRADING CU.YDS. ACRES Ping. Ref. # Park.Fees $ O I
LICENSED CONTRACTOR DECLARATION Remarks: - , ' Parking Req./Provided ' _ 1
I hereby affirm that I am licensed under provisions of Charter 9(commencing ' ' R
-•Ith Section 7000) of Division 3 of the Business -'Professions Code, and • •• I Use of Building: E
•
license-Is in ful fora a tl effect. - - M
cense CI s - - /' •'cense Z • . PLUMBING FEES Planning Notes: •
Date'' Signature - Ana _ i' E
WORKERS'COMPENSATION DEC LA RAT ON' Bar Sink • Showers - N
• T
' I herebyeffir_m that I have a certificate of consent to self nsure or a certificate . Backflow Preventer Service Sink - • S
'of Workers' Cainpensation 'Insurance, or a certified copy thereo action - _
3800, Lab. C.). �o `_J Backflow Irrigation Sewer Cap ' .'. ELECTRICAL •
FEES •
Policy No.-rt-7P'9S/J~�Z CompanYX .��:� ! Nr - .
•
Certified copy is hereby furnished. Bathtubs Sewer Connection • Automatic Washer, - Transformer ❑ 15-50 KW .-
.yCertified co is filed with the•clty B wisio•. - 0 50+KW
Date .' /r//pyAt- ' Applicant - ' - fa Clarifiers Solar Collectors -• Construction Pole Sub. . -
EXEMPTIONFROM'WORKERS'CO a DECL•'-ATION Dishwasher Solar Piping
(This section need not be completed If the permit is for one 'undred ($100) or � P 9 Cooking Unit Meter ❑up to 100 amps
less)' DrinkingFountains -
1 certify'that,in the performance of the work fob,fch this •-rmit is issued, Solar Tank - Dishwasher Meter Clover 100 amps -
• shall not employ any person in any mann Yo bac:/e subject to the •
Workers' fpm en ati Laws of Californl. ' - Floor Drains Swimming Pool w/Spa, Dryers ❑Gas ❑Electric • Sub Panel '
Date 'iter /j�//}R'�r Signature ' at '- .5/✓ • - - - -
—
, NOTICE: If;aftdr making this dedlaration, '`sho'tl.bec• e.subject to the Floor Sinks, ,. - - -Urinal __. _ _. -. Fan • . '-
Workers; Compensation provisions of'the Labor. ode, ou must forthwith - - Motors ❑0-1 HP 01 Y.-8 _
comply ,with such provisions..or -this -permit,shall .be deemed revoked. j Gas Service Outlets Water Closet ! '- F.A.U. • .Inc.Solar 09-15 HP 016-15+ •
CONSTRUCTION,LENDING AGENCY I - - ` -
I hereby affirm that there is a construction lending agency for the performance I _ Water Heater, Fixtures Microwave
of the work for which this permit. Is issued (Section 3097 Civ. C.) �q " s .
Lender's Name • = I KitchenSink� - ac. (j(J Water Service - ' ,- Device Boxes Pole Light I '
Lender's :Addres ' -
s _
' OWNER BUILDER DECLARATION ' . 7. • ' • I Lavatories " - ' • -• . Outlets • ' I Range • ••
I hereby affirm that I am exempt from the'Contractor's License Law for the p_Tra!allowing reason reason (Section;7031:5 Business and Professional Code: Any city or ' i ; p - - - . . . '1 Switches I ' Sign '
county which requires a permit to construct,alter Improve,demolish or repair . . . •
any structure, prior to its-issuance,also requires the applicant for such permit . _ • 'Roof-Drains . . Garbage Disposal Standing Sections • '
'to file a signed statement that he/she is licensed pursuant to the provisions of ' _ _ - - I _
the Contractor's License Law(Chapter 9(commencing with Section 7000)of -- ' Generator 00-5 KW❑5-15 KW - I '
- Division'3 of the.Business and Professions Code)'or that he/she is exemptTrash Compactor • '
'therefrom and the basis forithe alleged exemption. Any-violation of Section • •' - ' • - '
7031.5 by any applicant for'.a permit subjects the applicant to a civil ' •
anally of not more than five hundred dollars($500). - , Reinspection Fee $25 Issue Fee : •
' ' $ 3,
•
-U 1,•as'owner of the•property or'my employees with wages as their sole - Reinspection Fee I $25 Issue Fee $'3
compensation will do the work,and the structure is not intended or offered , MECHANICAL • FEES
for sale (Section 17044, Business and,Professional Code: The Contractor's -- - ---- — - --- - PUBLIC SERVICES REQUIREMENTS:
License Law does not apply to an owner of a property,who'builds or improves . Bdiler -- • Hood or Type I 0 -
thereon, and who does such work himself/herself or through his or her own - : 01 Zoning Approved By • Date
employees, provided that such improvements are not intended or offered for Canopy r Type II 0 , _
sale. If, however, the building or improvement is sold within one year of com- Duct-Under Ground _ Application Approved By Date
•
pletion, the owner'will'have the burden of proving he/she did not build or im- - ?
LIorve-for the purpose of sale). • • ' Duct-Structural Refrigeration System _. ,Application Issued By / l�/ Date J
I, as owner of the property,•am exclusively contracting with licensed con- Op-100,000 BTU ❑100,000 BTU '
• tractors to construct the project (Section 7044,Business and Professions Code: Duct-Ventilating ' I -SUMMARY OF FEES •
The Contractor's License'Law does not apply to an owner of property who -• _. - BUILDING,PERMIT $ • SMIP $ ,
builds or improves thereon, and who contracts for such projects with a con- Exhaust System 0 Multiple O' System Repair/Alteration $ • I PERMIT
tractor(s) license pursuant to the Contractor's License Law). i - l p CK ' • `
O'tam exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. ICBO•# • ISSUANCE $ ` '
• ' I PLUMBING $ 5-.00 s
Date owner, ` • Heating System&Ducting ' LAN CHECK $ ENERGY P.C. $ _
I hereby certify_that I have read_this .•• ication and state that.the above ❑0.100,000 BTU.D100,0006TL— - GRADING $
information is correct. I agree to co r• y with all city and.county ordinances - r - ' - ELECTRICAL I $ ' `
and state laws relating•t• 9 '•nstruction, and hereby authorize repre- - I ' - PLAN CHECK $
.j MICROFILM $ '
sentatives of this'city �•- pon t e - e-mentioned ,proAe ty for ' , -
i 11
Inspection p poses. L_ a 3// Isj� • _ i MECHANICAL ' $ ' • TOTAL FEE i $
5specti re L Yate ( / -
.
CMF 0865-46-rev, 1/83 White y-Building;Canary-Applicant;Pink-P:ccountirig;Goidenro8-ASSeSSor - - - --` -- - - '" '- - - - - '` - •�' - -
•
• CONSTRUCTION AND PLANN.. - - H /OOL &SPA . -
APPROVALS Permit# 39(V-fit-39(V-fit- Date 7 •Inspector • .APPROVALS Permit# ,. Date Inspector,
1. Temporary Electric& Service or Pole=. , , - , 1 52.1 Pool & Equipment Location '
2. Soil Pipe-Undrgrnd. j- 53. ,Steel Reinforcement • . "
3. Electrical'Conduit"Utility Undrgrnd. ' - • - 54. Forms . . . . , . • -• • .
4. Electrical Conduit-Undrgrnd. i;, 55. Electrical Bonding ..
'5. Steel Reinforcement.- - '56. •Rough Plumbing &Pressure Test ' •
6.' Electrical"UFER Grnd'. . 57. APPROVAL TOCOVER-GUNITE - 1,
7. Footings' . . •. . -
58. Electrical Conduit-Undrgrnd. . • '
8.'Foundation ' - 59. Gas Pipe, 0 Undrgrnd.,Test .
9. Water Pipe-Undrgrnd.{ - , •- • ' 60. ;Backwash Lines,-P-Trap, 0 Undrgrnd: -
10. Structural Floor System 61. -APPROVAL TO DECK • . .
11. Property Sewer Line'& House Connection 62..Backwash & Receptor-Final ; •
12. Sewe;;Cap ' �- I - - 63. Heater & Vent-Final - - '
13. Roof Drains 64. Plumbing System - Final - .-
14. Rough,Plumbing :-' - 65..Electrical-Final -
15. Rough Electrical-Conduit • . 66. Solar System-Final,-- ' . • , . - ' --
16. Rough Electric Wiring - ' 67. Fenci•ng & Access'Approval - -
17.:Rough Wiring Sign ' ' 68.. APPROVED FOR PLASTERING _
18. Rough Electribal-T Bar Ceiling 69. F00L/SPA•SYSTEMS FINAL •
19. Rough Heating & Air Conditioning , 'EIRE DEPT. REQUIREMENT 4 •
20, Rough Factory Fireplace APPROVALS Permit#
21: Ducts, in Structure • 70. Underground Hydro
22. Ducts:Ventilating, 71. Product Piping 0 Gas ❑Oil ,
23. Gas Pipe-Rough &Test 72. Underground Flush . •
24 Roof Framing, - '73..Undergrnd.Storage Tank 0 Gas 0 Oil
--,25. Roof Sheathing 74. Overhead Hydro
28. T-Bar Ceiling (Structural) & Monocoat : ' 75. Dry Chemical
27. Frame and Flashing , 76. Dry Standpipe ` "
28. Lathing & Siding •• . 77. FIXED SYSTEM FINAL .
29. Insulation • , 78. FIRE PREV. FINAL '
30. Drywall Nailing HEALTH DEPT. REQUIREMENT - .'
31.,.Plaster Brown Coat 79, FINAL INSPECTION '.
32. Electrical Power Meter-Final ' • 80. FOOD CERTIFICATE ISSUED • . .
33: Final Electric Notes:k0-r- 22.40,4 c.ro21tisiz 3fr•SiBNice/
•
34. Final Heating.& Air-Conditioning
35. FinalGas Pipe-Test - • , . r
36. Hood or Canopy t . , . . ' 1
37. Final Factory Fireplace , . - # - I .
38. Final-Plumbing •Wzgent LEO '
39. Water Service-Final • - •
40. Gas Service-Final -
41. Solar Domestic-Final
42. Backflow Preventer • ',-
43. Backflow Irrigation •
44. ,Lan`dscape Irrigation System
45. Sound Attenuation - 1. . '
46. Handicap Regulations - r
•
47. FINAL STRUCTURE & BUILDING . ••
48. Special Requirements Completed
49. Electiie Release to Edison - -- - - -
\i 50. Gas Release to Southern California Gas Co - • ,
51. CERTIFICAT,EOF OCCUPANCY ., -- - .. '- '
No. Date ' , t J
I7931 FE RECEIVE
COSTA MESA BUILDING-SAFETY DEPARTMENT OCT 1 196
P. O. BOX 311 COSTA MESA. CALIFORNIA F�NAf�CE DEPT.
CITY OF COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR
PRINT BUILDING
D
ADEISS '�1'LIJ�I�j
COSTA MESA. CALIFORNIA For Office Use Only
£ f°4ETrer GUSCr 97 1/166T1,P2E RECEIPT NO. I IF7IN,T8
ADDRESS /(OBJ J /1/..e/Ce� RECEI D BY I DAjE R EIS¢De OATEEVJIB3':1
/` A, �J ���j `/��J/ ////JOY�� �r% C}L/I�6�3/`1196.:
CITY (�J�j�Q.. ,(✓/ NE 7��i ADDRESS aQ/,c (�.(iL�fei�.rj !.Gy[
...-
ARCHITECT La��,�. /� ^L i/tEL. COSTA MESA. CALIFORNIA
OR HITENGINEER
/�1S J� �j4r(/Lg7�i7+ ?NO. /
ADDRESS /YN/��/C/'v, - FIRE V j a-
'/ �j� /� / ZONE TYPE GROUP
CONTRACTOR ,4._4IOj/2t'/'S,T �T /,,.�/,�J�/// [Q 1 BYPROVED DATE
ADDRESS /44(moi Aibl (teal+ ZONING
CITY ) /� •
ZON� / I PLANS - I DUIE LDINGEW - l7Jti/y
STATE / 1� 7//6 TEL. A/ �.(3�� LEGAL
IIIAL ,(moi //
LIC'NO. a / le NO' J` I V DESCRIPTION O �- � �L
•
SIZE ./ X / NO. OF BLOCS. L
OF LOT ( D / NOW ON LOT A.P.NO /-"? ?- /OZ - 3/
USE OF .I e; / e4XE YARDS EVES
USE NG BLDG. Lr7l A/L��(.rYiL .�J APPROVED ALLOWED
SETBACK LINE FROM 411 REAR YARD L� FRONT
(CENTELINE ST.) ,/ FT. IN.
CENTER OF STREET ^y /'�
SIDE YARD I LEFT c I RIGHT 7 R.SIDE `s--FT.
DESCRIPTION OF WORK • --
L.SIDE LS FT. IN.
•
NEW I XII ALTERATION I II ADDITION REAR 2..6 FT. Q/ IN.
REPAIR ^I II
MOVING I DEMOLISH I APPROVED /4,reQ� DATE /f,,."cL
SIZE
/coo RNO. OF 6OOMS STORIES / uJ'� !/
ROOF
COVER NGJWGj/EV/NIVi b I COVOERRINPG 5,x.4-kc
rot
E3rfryil7- ��
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS RE ULATING
BUILDING C/OOyyqq//TRUCTIO VALUATION j' ��
SIGNATURI�F��Q� PERMIT FEE $ �J �• 0
PERMITTEhh ~//../ _
$ / bit1TOTALFEE
PLAN CHECK $ o3 C 4-0 4
AUTHORIZED 441-4fela
p
i $ 96. 4-8 O
/ LL